I tend to use a mouse, as I really struggle to find my VR controllers, wherever i try to put them.
However, mouse alternatives do have the potential to be so much better. For example, a DCS user set up his own business selling something called PointCTRL, for DCS, which is basically a ring, or two IIRC, that effectively allows the mouse to be simulated, in a perhaps more intuitive/realistic manner. A real benefit is that you can keep it on your finger and it doesn’t interfere with your ability to use a stick, yoke, throttle or other physical controls.
“Empty-hand” tracking might also have some potential, but from what I’ve seen so far, it’s not there yet, at least with MSFS.